Abstract:

Background/Objective: Several case reports have described psychosis or mania in patients abusing
dextromethorphan. In each of the cases of mania, the symptoms resolved rapidly after the dextromethorphan
was metabolized. To our knowledge, no cases have been reported of an underlying diagnosis of bipolar disorder
that has been revealed by abuse of dextromethorphan. This report describes such a possible case.

Method: We describe clinical observations and treatment of patient who received standard level of care for
bipolar disorder.

Results: Our patient presented with symptoms of mania after ingesting 300 mg of dextromethorphan. His
symptoms lasted for over one week after the dextromethorphan was out of his system, even after an antimanic
agent was started. This is a significantly longer symptomatic period of time than has previously been
reported in the literature.

Conclusions: While this case technically meets criteria for dextromethorphan-induced bipolar disorder according
to DSM-5, we suggest that the prolonged course of symptoms may be more indicative of a primary
bipolar disorder. We propose that this case might be more similar to the unmasking of bipolar symptoms by
anti-depressant medications, which would be supported by the hypothesized acute anti-depressant effects of
dextromethorphan.

Abstract:Background/Objective: Several case reports have described psychosis or mania in patients abusing
dextromethorphan. In each of the cases of mania, the symptoms resolved rapidly after the dextromethorphan
was metabolized. To our knowledge, no cases have been reported of an underlying diagnosis of bipolar disorder
that has been revealed by abuse of dextromethorphan. This report describes such a possible case.

Method: We describe clinical observations and treatment of patient who received standard level of care for
bipolar disorder.

Results: Our patient presented with symptoms of mania after ingesting 300 mg of dextromethorphan. His
symptoms lasted for over one week after the dextromethorphan was out of his system, even after an antimanic
agent was started. This is a significantly longer symptomatic period of time than has previously been
reported in the literature.

Conclusions: While this case technically meets criteria for dextromethorphan-induced bipolar disorder according
to DSM-5, we suggest that the prolonged course of symptoms may be more indicative of a primary
bipolar disorder. We propose that this case might be more similar to the unmasking of bipolar symptoms by
anti-depressant medications, which would be supported by the hypothesized acute anti-depressant effects of
dextromethorphan.